Objective: To simultaneously examine characteristics associated with prescription opioid use, misuse, and use disorders among US adults and assess correlates of their motivations for prescription opioid misuse.

Methods: Data were examined from 51,200 adults 18 years or older who participated in the 2015 National Survey on Drug Use and Health. Prescription opioid use disorders were based on DSM-IV criteria. Bivariable and multivariable multinomial logistic regressions were applied.

Results: Prescription opioid use disorders were associated with ages 18–29 and 30–49 years, male sex, good/fair/poor health, suicidal ideation, and tobacco use, alcohol or cocaine use disorders, heroin use or use disorders, and other psychotropic medication misuse or use disorders. Among US adult prescription opioid misusers, 63.4% reported that the main motivation for their most recent misuse was to relieve physical pain, followed by seeking to get high (11.6%) or to relax (10.9%). Sociodemographic characteristics, mental illness, and specific substance use and use disorders were associated with specific motivations for misusing prescription opioids. Among adults with prescription opioid use, reporting pain relief as a motivation for prescription opioid misuse was associated with suicidal ideation, cannabis and heroin use or use disorders, cocaine use disorders, and other psychotropic misuse or use disorders.